Factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs

Abstract

OBJECTIVE To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs. ANIMALS 170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016. PROCEDURES Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors. RESULTS Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs. CONCLUSIONS AND CLINICAL RELEVANCE These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.

Perioperative Outcome in Dogs Undergoing Emergency Abdominal Surgery: A Retrospective Study on 82 Cases (2018-2020)

“…In human medicine, the most common procedures performed in the emergency setting are intestinal surgeries [2,11,19]. We found similar results, but, whereas the most common indication for humans are intestinal obstruction caused by adhesions or neoplasia [2,10,11,19], gastrointestinal foreign body causing mechanical obstruction was the most common indication for surgery in the present study, which is in accordance with previous research in gastrointestinal emergencies in dogs [20,21].…”

“…The most commonly encountered postoperative minor complication was anorexia, documented in 41/82 (50%) dogs, followed by tachycardia (n=25), diarrhoea (21), hypotension (18), reduced intestinal motility (17), melena (14), vomiting (12), fever (12), abdominal pain (12) and surgical site complications (5) 6.…”

“…The 15-day mortality rate in this study was 20.7%. There is no comparable veterinary study with which to compare data, however, mortality rates reported in veterinary medicine for the most common surgical procedures encountered here, like gastrointestinal, hemoperitoneum or GDV syndrome surgeries, range from 0.8 to 28% [21][22][23][24][25][26], 12 to 36% [27,28] and 12 to 26 % [29][30][31][32][33][34][35][36], respectively.…”

Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: A retrospective study by the Society of Veterinary Soft Tissue Surgery

“…Increased preoperative lactate has been correlated with poorer outcomes in dogs undergoing gastrointestinal surgery. 19 In addition, admission lactate >4 mmol/L and lactate clearance have been proven to be good prognostic indicators in dogs with septic peritonitis. 20 A high lactate may be reflective of intestinal ischemia or systemic hypoperfusion 21 ; therefore, it is not surprising that increased lactate was found to be associated with intestinal necrosis and perforations in the current study.…”

“…Risk factors for intestinal necrosis and perforation included duration of clinical signs, increased preoperative lactate, the presence of linear foreign material, and timing to surgical intervention. Increased preoperative lactate has been correlated with poorer outcomes in dogs undergoing gastrointestinal surgery 19 . In addition, admission lactate >4 mmol/L and lactate clearance have been proven to be good prognostic indicators in dogs with septic peritonitis 20 .…”